Author: Yun (Rose) Li
Burnout amongst scientists and physicians is a silent epidemic.
Teenage and young adult suicide rides have continued to rise, and mental health issues are a pressing issue among undergraduate and high school studies. Our universities and workplaces have become a hunting ground for competition and bullying. Meanwhile, the amount of knowledge and skills required to succeed in the biomedical sciences have exponentiated. Coupled with an ever more difficult funding environment, training pathways and copious documentation for healthcare professionals, it becomes ever more important to address burnout for those in the biomedical field. I write about burnout not because I have the perfect solution to offer, but because it is a struggle I face every day.
In grade school, I had this “rule”. I never went to bed without finishing all of my homework and chores, the former for fear of a bad grade and the latter for fear of being grounded by my mother. But some time in high school, this rule went from feasible to challenging, from difficult to impossible. After a 10 hour school-day, 2 hours of tennis practice, 3 hours of piano scales, I would fall asleep at my desk at 11pm having done about half of my homework. I resorted to sleeping on the floor, often waking up randomly at 2am and working till dawn to finish.
This was the start of a slippery slope. Over the course of the last decade plus, I sacrificed more and more of my sleep and physical health to “finishing” my day’s work. Finally, one evening, I realized that even if I didn’t sleep at all that night, I wouldn’t finish half the things that were due yesterday. I tempered my frustration only by pushing harder, reaching for more. I got busier in college. And before I knew it, I was in graduate school and now residency.
Before sharing with you my advice about burnout, I should also say that burnout is not about the number of hours one works. It is directly tied to how we feel about the work that we do and how much we are appreciated by the people around us. Is our work rewarding? Do we feel fulfilled? Is our time valued? Are our voices heard?
Learning to handle stress, uncertainty, failure and feelings of inadequacy are critical, as is the ability to find support and camaraderie, in the path to professional advancement.
Prioritize. The first thing I learned to do was to stop trying to do everything. There are times when everything on your to-do-list simply cannot be done. Admit that, and accept that. The quicker you do, the sooner you can get on to getting something done. Sitting like a deer in headlights will only result in a traffic collision. Once you decide on the one thing you have to have done that day (or hour or week etc), do it. Forget about the other things on the rest of the list until you finish this one. When you have one goal and one priority in front of you the insurmountable mountain becomes a climbable hill. Don’t despair all day over what you cannot or did not get done. Recognize that this is useless and you are only undermining yourself. Success (and failure) are not black and white. Those of us who are prone to burnout tend to think in two colors: black and white. The term in psychiatry is “all or nothing thinking”. We strive for perfection and anything short of that ideal equates to failure. We beat ourselves up for any mistake – “How stupid am I? How clumsy am I?” In the heat of the moment, I urge you to compose yourself. I assure you that some weeks down the road, you will have found that the sharp emotions you felt at the time of a major setback or disappointment to be irrational and blown out of proportion. While disappointment is hard to temper in the moment, think for a moment about how you would handle the situation if it were your friend who faced the same setback. Would you tell him or her “You are stupid” or “You are clumsy”? Recognize for yourself when the voice of self-criticism becomes counter-productive and use that to stop the need to punish yourself for something you cannot control. Give a little of yourself to someone or something else. One of the cardinal features of burnout is a sense of detachment from the world. We find it hard to care. We find it hard to empathize with those around us. One of the most helpful interventions I use is the act of doing something nice “out of my way” for someone else. Maybe it is to buy a box of chocolate or some flowers for a friend in need or to help a coworker after a long day at work. It is doing something not asked of you or ever expected. More often than not, you will find sincere gratitude from whoever you help. Doing something good for someone else will give you an opportunity to feel good about yourself and build relationships with people who can offer you support in return. It is a double win. Being able to feel good about something you did and that you can make a difference in someone else’s life can add joy and temper the disappointment in your own life.
Know your boundaries. In order to succeed we all have had to push ourselves. We have all had to make sacrifices we didn’t want to make. These compromises are inevitably necessary to be competitive for graduate or medical school, to get the job or promotion that you so much wanted. However, there is a breaking point, a limit to what we are willing to sacrifice, at which point any further compromise would make you unhappy and put your mental, physical or spiritual health at risk. Recognize it when you approach to these boundaries. You might not be aware of this boundary early on in your professional life but I assure you that you will eventually recognize its existence. Maybe it is working past 7pm on Friday night, maybe it is sleeping less than 4 hours a night, maybe it is skipping lunch. Whatever it is, recognize it. Once you find it, respect it. Do NOT ignore it. Repeatedly breaking this boundary will make you unhappy, bitter and angry, and you will end up taking it out on those you love or it will implode when you are doing the work that is most important to your future.
Ask for help. When I compare individuals who deal well emotionally with stressful situations compared to those who do not, I notice one immediate difference. Those who suffer the most are those who are too proud, shy or afraid to ask for help. Don’t be. I was always the one who never asked. Many times I have been told by those around me that I hide my insecurity and my lack of confidence “well”. This is perhaps meant as a compliment but it is a detriment to your success (particularly in the world of medicine). By admitting that you need help, you give others an opportunity to lend you support and advice. Sadly, it also makes other people proud to be able to help you and “makes them feel good about themselves”. Being too independent and seen as being unwilling to ask for help will isolate you and make you appear overly confident and arrogant, even if on the inside you doubt yourself but just “hide it well”.
Find a friend who will listen to you complain (but not for too long). Everyone needs a shoulder to cry on, a shoulder that is always there and never judgmental. Find a person in your life who loves and respects you for who you are, and whose love for you would not be clouded by your own moments of doubt or feelings of “self-worthlessness”. But don’t find a sponge. You need a friend with a spine – one who is not afraid to tell you when you have moped for too long and it’s time to move on.
Work hard, play hard. When it is time to relax, relax. When you are on vacation, enjoy it This is, believe it or not, the most difficult skill to master in this list of tools. I used to look at “relaxation” or “time-off” as a waste, worrying constantly about what I “should” or “could” be doing while I’m out at the movies or playing a video game, etc. Then when I return to work or school I am more anxious and guilty, than rested. Everyone has a different definition for what it means to be “off”. Some don’t read emails. Some turn off their phones. Regardless of what your rules for truly taking “off” are, once you decide on it, make that your policy and take that time off. For me, it is to limit the amount of “work” related activities to the minimum possible and absolutely less than an hour a day when I’m on vacation. I stopped feeling bad for enjoying myself. When I learned to truly appreciate the time I had off and to be free from that guilt, I found myself refreshed when I returned. I was eager and excited to work on projects I had been sick of before I left.
Five minutes a day. It might be hard to find half an hour or an hour to do the things you love, but anyone can find 5 minutes. Even in the most stressful of times taking a few minutes at a time out can help you focus and regroup. For some, this 5 minutes is a time for meditation, for other 5 minutes to call a friend, but it doesn’t have to be defined by anyone else. I use my 5 minutes to be mindful. It sounds silly but before you dismiss it, try it. I use my five minutes to remember not to stress the small stuff, step back and look, reassess where I am and to not sweat the small stuff. I remind myself that there are few things in life really worth stressing over. I realize that the “disasters” are not that, that disappointments all come to pass. I spend my five minutes reminding myself of what is really important, that few things in life really matter.
Find your passion at work and at home. Sometimes when you are unhappy it is hard to find pleasure or joy, even in the things you love. The medical term is anhedonia. In fact, anhedonia is one of the diagnostic criteria for major depressive disorder in the DSM. Recent studies have shown that when people experience anhedonia, they can still derive benefit from doing the things they once enjoyed even if they don’t actively perceive pleasure. Put more simply, find something you like to do and make sure you make time to do it even if you are stressed or have little time.
Have a goal, but make the journey worthwhile. Remember that you have one life to live, and there is a chance you might never make it to that destination. So enjoy the journey and make sure that you live every day like it is your last. If you looked back at your life, would you do something different? Would you take the time to enjoy the beautiful things there are around you if you never saw them again? As a physician who takes care of patients at the end of life, I spend my time listening to many patient’s last thoughts. Those thoughts are not filled with regret for lost ambition or for wanting to “get that checklist done”. The most frequent regrets I hear are those about having lost the opportunity to spend life with the people they love doing the things they enjoy.
At the end of the day, all of my advice is focused on one thing. Learn to love and value yourself for what you bring to the table and don’t let the motions of doing “what you need to do” become so heavy a burden that you forget why you are doing it.